Healthcare Provider Details

I. General information

NPI: 1881246916
Provider Name (Legal Business Name): STEPHANIE MARIE PEREZ MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 BEE CAVES RD STE D310
AUSTIN TX
78746-5753
US

IV. Provider business mailing address

508 DEEP EDDY AVE
AUSTIN TX
78703-4555
US

V. Phone/Fax

Practice location:
  • Phone: 512-956-6463
  • Fax:
Mailing address:
  • Phone: 512-956-6463
  • Fax: 512-469-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number77577
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: